Active NPI
Gordon Cleland Fraser Jr., DMD
- Periodontics
- Conyers, GA
National Provider Identifier
1306034871
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Periodontics
- License
- DN012684
- Practice address
- 1916 Iris Drive
Conyers, GA 30094 - Phone
- (770) 483-4469
- Fax
- (770) 922-0401
- NPI assigned
- Oct 10, 2007
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Periodontics | 1223P0300X | DN012684 | GA | Primary |
Addresses
Primary practice location
1916 Iris Drive
Conyers, GA 30094
Mailing address
P.O. Box 2213
Peachtree City, GA 30269
Phone (770) 483-4469
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| DN012684 | GA | MD | Periodontist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Conyers Dentures & Implant Center | Periodontics | Past | Accepting new patients |
Organizations & group practices 1
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.
-
- Periodontics
- Conyers, GA
- NPI 1487842951
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1191974400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1462233600000",
"number": "1306034871",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "P.O. BOX 2213",
"city": "PEACHTREE CITY",
"state": "GA",
"postal_code": "30269",
"telephone_number": "770-483-4469",
"fax_number": "770-922-0401"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1916 IRIS DRIVE",
"city": "CONYERS",
"state": "GA",
"postal_code": "30094",
"telephone_number": "770-483-4469",
"fax_number": "770-922-0401"
}
],
"practiceLocations": [],
"basic": {
"last_name": "FRASER",
"first_name": "GORDON",
"middle_name": "CLELAND",
"name_prefix": "Dr.",
"name_suffix": "Jr.",
"credential": "DMD",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2007-10-10",
"last_updated": "2016-05-03",
"status": "A"
},
"taxonomies": [
{
"code": "1223P0300X",
"taxonomy_group": "",
"desc": "Dentist, Periodontics",
"state": "GA",
"license": "DN012684",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Conyers, GA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 3, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.